INTRODUCTION TO HANDS FREE TECHNIQUES
In the West, Swedish Massage has been the norm for the beginning of training as a massage therapist, but as the demand for massage in the West grows, we need to look at the problems some of the common techniques can cause use if overused, especially when using the thumbs.
In the massage world today, statistics show that the working lifespan of a therapist is between 7 and 10 years if you are not coming into the industry already carrying injury or wear and tear to thumbs, fingers, wrist, shoulders and more importantly backs. Repetitive strain is a major cause of therapists having to give up their practice.
The following information gives you guidelines to help you fulfil your desire to be a therapist for many years to come. Ask yourself at the end of a working day how does my body feel?
Protecting your career is very important, noticing as you are massaging if there is any strain in your body, as it will be this repetition that will cause you problems long term.
Try building your tool box with strokes and techniques that will help you work with little or no strain in your body. Ask yourself what bad habits have I allowed myself to develop when massaging, as it is these habits that accumulate to cause you pain and discomfort.
Learning to use your whole body and keeping your body moving throughout any stroke is important and always using other parts of the body rather than using some of the smallest digits on the body i.e. thumbs and fingers. Learning to use elbows and forearms is a major help in preventing injury to yourself.
KNOWING YOUR LIMITS
Always work within your capability, being totally aware of your own fitness level and your limits of stamina and strength; exceeding these limits will inevitably cause you problems.Keep your self fit and active:-
WALK YOUR TALK
How often do you hear a therapist say they don’t get massaged, using the excuse they don’t have the time? If you don’t look after yourself then how can you take care of your clients? A question for you to ask yourself is how often do I encourage my client to have a massage, once a week, once a fortnight, once a month? Then that is what you should be doing for yourself. In addition, why would you not support the industry that you are in? If we as therapist don’t get massaged and support each other, how can we expect others to? Food for thought!
GOOD BODY USE
Your size does not matter when massaging if you are in good shape yourself. By using your whole body properly when massaging, you can be a very effective therapist, adding depth and power to your massage.
If you apply your strokes and techniques in easier ways and keep your whole body moving during a treatment, using your weight more rather than straining specific parts of the body, this will make a massive difference to how long you can massage for and how many clients a day you can effectively treat.
Being totally relaxed when massaging is critical to the client response to the massage. If you are tense or straining you can guarantee the client will pick this up on some level, therefore they will find it difficult to relax and let go of their own body’s tensions.
Know that the first touch you give your client is the most important touch; if this is done in the right way then the client will respond accordingly, if the touch is hard, fast or just matter fact then this will also determine the outcome for the client.
Balance throughout the therapist’s body is also important, so one side of the therapist’s body is not used more than the other. Being left or right handed will often determine which side we use the most which can lead to overuse of one or the other hand. The clients will also pick up on imbalance from the work of the therapist, if they feel balance in the massage received then that can travel through to their tissues.
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GOOD PRACTICE
Where ever possible avoid straining your thumbs, fingers, wrists. When working larger surface areas such as back and legs use the forearm, making sure you not using the ulna edge as this will be uncomfortable for the client. Use the thicker part of the arm close to the elbow with the palm facing down this will be much softer and if you use your body weight you will be able to effectively get deeper into the body than you can do with the hands anyway and you will be covering a much larger surface area using the whole of the forearm.
Practice using your elbows on family and friends who will give you honest feedback, until you get used to feeling through the elbow. Using the elbow requires very little effort on the part of the therapist, but needs lots of awareness when using this sharp, hard tool. Then you can use the elbow rather than the thumbs if you are doing trigger points etc.
Using the flat of the knuckles will also help you protect your hands. When you clench your fist, gently use the flat of the back of the fingers, the area from the edge of the knuckles (metacarpals) of the fists, to the proximal phalanges. Keep your arm and fist in a straight line, this is a very powerful stroke which is easier for the therapist but deeper for the client - again great over large surface areas such as the back, upper thigh and back of calf.
It is always good practice to go slow whenever you are performing a new stroke on a client until you are confident you have mastered it, then there is little chance of injuring or hurting the client or yourself.
KEEP YOUR BODY MOVING
Always move around the couch, never over stretch, make life easy for yourself and keep repositioning your body until you know you are comfortable and not causing any strain.
If you feel strain in your back then change your position, if your back goes then your can almost say good bye to a career in massage.
When applying a stroke to your client’s body, the movement should not come from the back down the arms to the hands, and no movement should happen from the legs, the movement should come from the soles of the feet. You should have a nice wide stance, push up through the sole of the foot, up the back leg, taking the torso forward and the front leg should begin to bend giving you momentum and flow forwards. To come back you need to push off the front foot, begin gently straightening the front leg to give you backward momentum to take you to your starting position.
Your massage should almost feel like a dance when working. constantly moving slowly and faster at times, but all the movement coming from the soles of the feet, so you are not relying on the smaller muscles of your body such as the arms and hands, but harnessing the power of the larger muscles through the legs and trunk of your body.
MASSAGE SPEAKS LOUDER THAN WORDS
You probably find when working on your clients that their muscles and tissues tell you a lot about what’s going on in their bodies. Well that communication is also reversed, if the therapist is relaxed, comfortable and delivers the massage with certainty, confidence, balance, strength and fluidity then the client’s muscles and tissues will register these as much as they can register hesitation, imbalance, weakness etc.
Therefore the Therapist‘s ease of working is equally as important as applying any specific stroke or technique.
Maintaining contact throughout the massage is also important, the client needs to know where you are, if you break contact for more than a second or two then the client is often unsure if the treatment has finished or if you have even left the room without them knowing. This will instil insecurity in the client. Remember that clients are always vulnerable when having a massage. It takes a lot of courage to undress and be exposed to massage, so sensitivity and understanding should always be at the forefront of the therapist’s mind.
Ensure spare towels, your oil and anything else you might need is within reaching distance so that you do not lose contact completely from your client.
PRACTICE MAKES PERFECT
Some bad habits we use in massage can easily be remedied if practiced, if you have a bad habit that is causing you concern in the body, find an alternative way of working and keep practicing until it replaces the bad habit.
Monitor yourself, after doing a treatment; ask yourself what am I aware of in my body? Is anything aching, paining or causing discomfort? Be aware if you are left or right handed and if the dominant hand is being overused. Keep the use of both hands even.
Don’t do the same strokes and techniques over and over again with each client. Learn lots of different ways to massage, so you do not create repetitive strain in your body. This will also stop you getting bored, as no two massages should be the same, as no two clients are the same.
TOOLS OF THE TRADE
Your most important tool is your therapy couch, this is worth investing in. Make your couch your best friend, it would be advisable to get a height adjustable couch and one that is comfortable for your client to lie on for a full treatment. Even if your couch costs you £1000.00 this divided by the average price of a massage £33.00 would only mean 33 treatments and there after you will be making profit every time you use the couch. A quality couch will also last you longer.
More importantly, using it at the right height will assist your posture. Working on a table that is too high will hinder and strain you, as will one which is too low. As no two clients are the same, you need to adjust the couch according to the individual client’s body type. Working with your couch at the right height will enable you to use your whole body to apply pressure, therefore reducing strain on your shoulders, arms and hands.
Notice if you are moving with every stroke you do, is your torso static and only your arms, wrists and hands moving? Make sure you move from the soles of the feet, driving the strokes from the legs and the hips.
Make sure there is space to move around your couch, overreaching is a major cause of lower back strain. It is good practice to always have your feet firmly on the ground, lower your body so your legs are gently bent.
Working with a couch that is height adjustable means you can work with the couch slightly lower thus allowing yourself to work symmetrically, by working from the head or foot of the table.
When as a therapist you first learn massage techniques, it is difficult not to put all your focus into what you are doing. As time goes on and you practice and master the techniques, then you can focus on your own body and how it feels to massage in this way. If discomfort or stain is being felt, adjust your position or change the technique you are using.
It is not good practice to put any strain on the body when working. If the therapist strains themselves or becomes incapacitated due to poor posture when working, this could lead to the therapist having to give up massage. If the therapist takes the time to be aware of the aches and pains when massaging and omits those strokes or learns new strokes, that will prevent strain and injury.
USING THE HANDS
Effleurage movement with the hands using the lunge stance, having one foot forward and one back is the technique that many therapists use the most. This is a very good position, enabling the massage pressure to come from the feet, through the legs and hips to create the momentum and evenness when applying a long flowing stroke.
As the whole body moves forwards, pushing with the back leg and bending at the knee into the front leg, the weight goes forward, allowing the therapist’s body to continue moving and whilst moving there is little room for strain. The pressure can then be adjusted to the clients needs, the deeper the lunge as your whole body goes forward , the deeper the stroke. Push back on the bent knee again from the foot, through the leg and hips, pushing the torso back to your starting position.
Remember breathing is very important for the therapist as well as for the client. Use your breath during each stroke, breathe in and when applying the stroke breathe out, this will allow you to relax and create a good rhythm.
USING THE FOREARMS
Forearms can be used one at a time or both arms together when working over the back.
If using both arms it is a little like doing the breast stroke when swimming. Stand facing the side of the couch and the clients torso. Stand with legs a good width apart for you and place both forearms close together across the middle of the client’s back, with both palms facing down, lying flat and relaxed on the clients back. Bend at the knees and then push up through the legs covering the nearest side of the clients back, with forearms going in opposite directions, adjusting the depth by how much you lean your weight on to the client’s back. Go round the table to do the other side. Using the forearm gives you greater coverage of the client’s back than using the palms. The wide leg stance with bent knees will take the pressure off your lower back.
When using one arm, use the wide leg stance, with the front foot pointing up the table, make sure the palm of your hands is face down so you are not using the ulna edge and creating discomfort for the client.
With your palm face down you are using the larger muscle of the forearm (Brachioradialis and the Extensor Carpi Radialis Longus) which are softer if the arm is relaxed and will mould over any bones such as the scapular. (Try putting your forearm out in front of you, clench your fist and with your free hand press on these muscles, they should feel quite hard. Let the hand relax and press these muscles again, they should be nice and soft, this is how they should be when massaging).
Stand with your back leg level with the hips of the client with wide stance and the front foot pointing up towards the client’s head. Rest the non- working arm across the folded down towel over the gluts, keeping this arm relaxed and using it for support to softly lean on the client as you work up the back with the other arm.
The working arm again should be palm down and kept soft and relaxed. Start the stroke at the lower end of the client’s back just in front of the draped towel. Push off the back leg slowly at first (the speed can vary as you grow in confidence with the stroke). As your torso moves forwards bend into the front leg and allow the working arm to travel up the side of the back you are working on, keep your body behind the working arm as you fall forward. (shoulder and elbow should be at a 45 degree angle). Complete the stroke to where it is comfortable for you without overreaching depending on the length of your client’s back and the length of your body. Push back off the front foot through the leg and hips to drive you back, just leave the weight of the arm on the client as you come back to start the stroke again. Putting pressure on the back on the return stroke would cause you back problems, so always keep the pressureon when you are moving forward and allow the weight to do the work.
This can also be done by starting at the top of the client’s back and working down towards the sacrum. Same as above, just make sure your back leg is level with your client’s head and your non- working arm can be rested at your side so you can cover the whole back from top to bottom. This movement with the forearm is also good over the backs of the legs.
USING THE ELBOW
Caution should always be observed when using the elbow. Get used to using your elbow when working on family and friends first who will give you honest feedback.
The elbow is a powerful tool if used correctly and a damaging tool if used incorrectly. The elbow is a great replacement if you know how to do trigger point work, first find the trigger point and what you have been doing with your thumbs you can now replace with the elbow. If the elbow is used regularly you will be able to feel through the elbow as you can with fingers and thumbs. You will also find you do not need to work very hard with the elbow to get great results, it often feels like you are doing very little work.
When using the elbow again make sure your posture is comfortable, you can use either stance as used with the hands or forearms, apply the elbow very slowly and you only need to lean in a little to be effective. It would be good practice if you feel the need to use the elbow to ask the client to let you know when you are in to the tissues deep enough for them.
A good way of using the elbow instead of thumbs would be when splitting the gastrocnemius muscle in the back of the calf. This is traditionally taught in Swedish massage using the thumbs.
To use the elbow, use a wide legged stance, standing straight on to the lower leg, gently placing the elbow on the base of the calf just above the Achilles tendon. Gently lean just a small amount of weight in and slowly work your way up the calf until you come to the top of the muscle, do not go over the back of the knee.
All the above techniques need practice. Be sure to keep repositioning your body, doing consecutive strokes, keeping your bodyweight behind your working arms. Constantly moving your body sideways, forwardsand backwards will keep the massage feeling smooth to the client and feel fluid and co-ordinated to the therapist. The massage should feel like doing yoga, thai chi, and a “dance” around the couch.
This may seem a little demanding to begin with but the old saying ‘practice makes perfect’ could not be more true. The practice will be worth all the effort and remember to keep dividing your focus between the client’s and your own posture.
EARLY WARNING SIGNS
Persistent aches, niggles and fatigue are all danger signs that could indicate that more serious problems could be further down the line if not addressed sooner rather than later.
Common problems present themselves by:-
• Persistent pain after massaging
• Hypersensitivity to bumps and bangs in those areas
• Pain keeping you awake at night
• Weakness, often in the wrists and hands
• Strain in the lower back
• Tense and tight shoulders
If you are developing any of these signs then consider addressing them sooner rather than later, if left unchecked they could lead to long-term problems. One of the best things you can do for yourself is get massaged.
WORKING ENVIROMENT
Checking and assessing your working area can also help with making life more comfortable.
SPACE
• Keep your room uncluttered
• If possible, natural light is good
• Take time out in fresh air even just for five minutes if you work in an air conditioned environment.
• Drink plenty of water to keep hydrated
PLAN YOUR DAY
• If you have control over your bookings give your self time between clients and make sure you plan time out in the day for yourself to replenish and rest.
• Don’t work beyond your physical capabilities, this is not only damaging to yourself but also you will not be able to give your client the best treatment you are capable of.
• Massaging is not only physically demanding but also mentally and emotionally, especially when your clients present with physical pain and distress through emotional issues that may arise during the treatment. You need to give yourself time to bring yourself back to a grounded state for your next client and enable yourself to switch off at the end of the day and not take on board your client’s problems.
• Pacing yourself is so important to prevent illness, getting rundown, especially during hormonal cycles or recovering from an illness.
• Reflecting at the end of each day on how you feel will enable you to reduce, adapt and change what you need to do to protect yourself.
• Ensure when doing your consultation for a first time client that you find out what their needs are from the massage, ensuring there are no contraindications and you are aware of your own limitations. Only work with any conditions you are trained to work with.
• If in doubt get doctor’s consent and if this is not available, best practice would be when in doubt ‘don’t do it’. Refer them if possible to someone you know that has more experience than you.
• Make sure the client is in full agreement with the treatment you are going to initiate, enabling you to meet the client’s expectations.
• Ensure you get feedback from the client during the treatment to make sure that at any point they feel uncomfortable or if the massage is too deep or too light for them they feel confident to let you know.
FINALLY COMPLETING THE TREATMENT
• Ensure you adhere to your boundaries and ensure you finish on time; otherwise client’s expectations will be that it’s ok to run over when they receive every massage. This can put you under undue stress, knowing the next client may well be waiting.
• You also need to have the space to disengage from the current client to enable you to then competently engage with the next. More so if the current client has left you with uncomfortable thoughts because of there issues or illness.
• Give your client your aftercare advice, to encourage them to get the best from their massage and the possible self healing process that may take place. This may come in the form of frequent visits to the toilet as the body detoxifies or experiencing disrupted sleep or vivid dreams etc.
• It would be a good idea to talk to your client about these, especially if it is their first treatment. Reassure them that it is normal following a massage and will only last 24 to 48 hours as their body takes the opportunity to detoxify.
Finally, remember you can’t help people effectively if you are not happy and healthy yourself.
Looking after yourself is the most important thing you can do if you want to help others - We hope you found this information helpful.
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